Keith Jordan 🛡🪢

Role of Neutrophils in the Innate Immunity of Normal healthy human Vagina with no inflammation. Surgeons can never replicate the role of innate neutrophils in their Deep Surgical Wound (DSW) lined by skin or in Bowel Vaginoplasty Wound (BVW). In the absence of pathological inflammatory conditions in the Vagina, HIV transmission rates are estimated at 0.08% per sexual act. This low transmission rate per act indicates the presence of natural barriers in the Female Genital Tract (FGT) that can prevent HIV infection in most cases following exposure. These barriers include a combination of physical, chemical, and immunological mechanisms exerted by epithelial cells, mucus, secretions, and innate immune cells. Among the innate immune cells in the Vagina, neutrophils seem to play an important role in the prevention. Neutrophils and NK (Natural Killer) cells are the two predominant innate immune cells in Vagina. What are Neutrophils? The white blood cells (WBC) in the circulating blood are the mobile units of body’s protective system against infections. Six different types of WBCs are normally present in the blood. An adult human has about 7000 WBCs per microliter of blood. They are neutrophils, Eosinophils, Basophils, Monocytes, Lymphocytes and occasionally plasma cells. Neutrophils are the majority among the WBCs with about 62% in the blood of a healthy human adult. It is well known that neutrophils circulate in the blood and they are actively recruited to sites of tissue infection through a process called chemotaxis (chemically attracted to the infected site). These neutrophils recognise the offending pathogens with the help of their receptors on the neutrophil surface. They then surround the offending pathogen with its own cell membranes and phagocytose the pathogen into its cell. Neutrophils contain granules that house enzymes like collagenase, elastase that can destroy the ingested pathogen. Once the bacteria/virus are inside the neutrophil, the granules that are toxic to the pathogen are discharged on to the pathogens and pathogens are killed. These mechanisms that is described above are well known to all medical professionals. What is new with neutrophils in healthy human Vagina? Uniquely, Neutrophils are present within the female genital mucosa under physiological conditions without concurrent inflammation. They are called innate neutrophils. Traditionally it is known that neutrophils are predominantly resident in circulating blood and they migrate to tissues when there is infection or injury. Recent immunologic research has unveiled presence of large numbers of Neutrophils in the mucosa and in the lumen of normal healthy human Vagina. Such large numbers of neutrophils have not been discovered in colonic or rectal mucosa under physiologic conditions. It is now increasingly recognised that the Vaginal mucosal neutrophils have a significant role to prevent contracting HIV infection in the event of a sexual intercourse with an infected individual. I believe that this is a phylogenetically evolved immune mechanism in females that may explain the very low incidence of HIV infection following an exposure to a HIV infected male. So how do neutrophils prevent infection even without initiating an inflammatory response? Neutrophils are abundant in the lumen of the Vagina naturally, where they act as one of the predominant cellular defence mechanisms against any invading pathogens. Neutrophils recognize pathogens through Pattern Recognition Receptors on its cell surface (PRRs). Toll Like Receptor (TLR) is a PRR on the surface of neutrophils whose activation results in multiple effector mechanisms to eliminate invading pathogens. These mechanisms are: 1.phagocytosis 2. release of reactive oxygen species (ROS) 3. granule release, and 4. formation of neutrophil extracellular traps (NETs). 1.Phagocytosis-means engulfing the bacteria/virus. 2.Reactive oxygen species (ROS)– TLR activated neutrophils converts molecular oxygen into ROS, which are highly reactive oxidizing agents with free radicals that destroys engulfed microbes. 3. Granule release- Once the pathogen is ingested into the cell of neutrophil, the granules of the neutrophil discharge their contents on to the microbes. This results in the death of the microbe. 4.Neutrophil Extracellular Traps (NETs)-Neutrophils also kill microbes by extruding their DNA and granule contents outside the neutrophils. These extruded intracellular contents form extracellular threads on which pathogens get trapped and killed. These are called Neutrophil Extracellular Traps (NETs). The extrusion of nuclear contents during NET formation leads to neutrophil cell death. Such a death of neutrophil to protect the body is called NETosis. In this process neutrophils sacrifice themselves to trap and kill the enemy pathogens. Several studies in both human and mice have highlighted neutrophils’ importance in protection against sexually transmitted infections (STIs) within the Female Reproductive Tract for their quick and robust response to invading pathogens. Within the context of HIV infection, neutrophils recognize the pathogen associated molecular pattern (PAMP) which is HIV-1 ssRNA (single stranded RNA) via TLR receptors 7 and 8. This Leads to downstream release of cytotoxic granules, ROS production, and NET Formation resulting in the destruction of HIV virus within the lumen of Vagina before the virus can even contact the vaginal epithelial cells. Conclusion: Surgeons who deceptively claim to “Create a Vagina” can never replicate such an effective innate immunity with neutrophils which mother nature has gifted to every woman with a healthy Vagina (without inflammation) on planet earth. I recommend to any person considering undergoing the deceptive Vaginoplasty surgery to read the scientific article published by the reputable urology journal. doi.org/10.1097/01.JU.000100… Reference: sciencedirect.com/science/ar… sciencedirect.com/science/ar… sciencedirect.com/science/ar… doi.org/10.1186/s40168-023-0… Dr. Joseph Chrysostom MS(Gen Surg), FRCSEd GMC 5199143.